Prevention and Management of Caries in Children

SDCEP published guidance on the Prevention and Management of Dental Caries in Childrenin April 2010. The guidance aims to assist and support Primary Care practitioners and their teams in improving and maintaining the oral health of their child patients from birth up to the age of 16. Based on information distilled from a range of sources, the guidance provides advice on:

the assessment of the child

the delivery of preventive care based on caries risk

choosing from the range of caries management options available

delivery of restorative care, including how to carry out individual treatments

recall and referral

providing additional support

management of suspected dental neglect

Diagnostic Analysis

A diagnostic analysis comprising four stages was conducted during the guidance consultation period.

1. Consultation feedback questionnaire

As part of the SDCEP consultation process the draft guidance was sent to various individuals and organisations and all GDPs were invited to comment on the draft. The questionnaire contained questions around the content and format of the guidance as well as the implications of translating the guidance into practice. More information on the implementation questions can be found in the summary report.

2. Semi-structured telephone interviews

Semi-structured interviews were conducted during the guidance consultation period with general dental practitioners (GDPs) and dental care professionals (DCPs). The interview schedule followed a standardised structure to identify salient beliefs regarding barriers and facilitators and advantages and disadvantages that relate to implementation of the guidance. The findings from the interviews can be found in the full report.

3. Pre-guidance publication survey

Prior to publication and dissemination of the guidance a questionnaire-based survey was sent to a random sample of GDPs across Scotland. The questionnaire was designed to investigate current practice for the prevention and management of child caries and to explore GDPs attitudes to the key behavioural outcomes.

Evidence from the diagnostic analysis indicated that despite these initiatives a significant gap between actual and optimal practice exists and is unlikely to improve with dissemination of the guidance alone. For example, results from the survey revealed that only 28% of GDPs always assess and record caries risk for their child patients. To prevent caries, 25% reported to always placing preventive fissure sealants and only 10% always apply fluoride varnish.

4. Post-guidance publication survey

A post guidance questionnaire was distributed approximately nine months after publication to identify any changes in practice following publication and dissemination of the SDCEP guidance. Results from this suggest that there was no significant change in relation to self reported practice or dentist attitudes towards the prevention and management of caries in children. Full details of the results from the pre- and post-guidance surveys can be found in the published article [1].

Evaluation

In order to explore the systems, organisational and patient factors that influence the delivery of optimal care in the prevention and management of dental caries in primary dental care a grant application was submitted by the TRiaDS collaboration to the Chief Scientists Office (CSO). The main objectives were to:

Identify the barriers and facilitators at the systems, organisational, professional and patient levels to the delivery of optimal prevention and management of dental caries in primary dental care.